U.S. Home Births Increase

by Amanda Chan | May 20, 2011 09:01am ET

North Idaho resident Tiffani McKinney had never really thought about home births before she had her first child. Her first daughter was born in 1989 in a hospital, and it wasn't a negative experience, but McKinney never knew there were other options.

But then McKinney and her family moved to a smaller town, where many women chose to have home births with midwives.

"I thought it was an outrageous concept," McKinney told MyHealthNewsDaily.

But then she did some more research, and was attracted to the quiet atmosphere associated with home births. She felt safe doing it because her pregnancy was not considered high-risk, and she had her second child, a boy, at home in 1995 with a midwife assisting at the birth.

McKinney went on to have two more children born at home, with her last home birth in 2005. She had her fifth child at a hospital because he was overdue and was causing her immense discomfort, but she had initially planned on having him at home as well.

McKinney is part of a small but growing segment of the population that is opting to have natural home births. In fact, home births in the United States grew by 20 percent among all women between 2004 and 2008, according to a new study.

Much of that increase comes from from non-Hispanic white women, a demographic that saw a 28 percent growth in home births during the time period, the study said.

Home birth rates for other groups, including non-Hispanic black women, Hispanic women, Asian-Pacific Islander women and American Indian women, barely increased or remained stagnant over the study period.

The study was published today (May 20) in the journal Birth: Issues in Perinatal Care.

Why a home birth?

Home births are still extremely uncommon in the United States there were only 28,357 home births in 2008 out of the 4.2 million births that took place that year, according to the study.

During a home birth, a midwife and a doula (a nonmedical childbirth assistant) are often present to make sure all goes as planned. Most women also choose to see an obstetrician/gynecologist during pregnancy to make sure there are no contraindications to giving birth at home.

Women may choose to have a home birth over a hospital birth because they want to deliver their child in a natural environment, they want to be surrounded by family and friends or they may have some cultural or religious concerns that are better accommodated at home, said study researcher Marian F. MacDorman, of the Reproductive Statistics Branch at the U.S. Centers for Disease Control and Prevention.

Cost may also be a factor, as home births can cost as little as one-third as much as a hospital birth, MacDorman said.

Past studies have also shown that women may choose a home birth because they want to avoid certain obstetric procedures like Cesarean section , induction or stimulation of labor, she said.

"Obviously, some women will need these procedures even in the case of a home birth, and a certain proportion of women initially laboring at home will be transferred to a hospital to get these procedures," MacDorman told MyHealthNewsDaily. "Still, women who plan to deliver at home have a lower rate of these procedures."

However, MacDorman said she wasn't sure why there seems to be a growing interest in home births by non-Hispanic white women.

Potential dangers

Home births are controversial among some groups, with studies claiming both their safety and their potential dangers. The practice is a concerning one to many doctors, and the American College of Obstetricians and Gynecologists issued a statement this year explaining its disapproval of home birth.

Giving birth in a hospital or birthing center is safer than birth at home, said Dr. William H. Barth, Jr., chief of the Division of Maternal-Fetal Medicine at Massachusetts General Hospital, and associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

"The absolute differences are small, but recent publications have consistently demonstrated a two- to threefold increase in neonatal death among planned home births," Barth, who was not involved with the new study, told MyHealthNewsDaily.

For example, a 2010 review of studies, published in the journal Obstetrics and Gynecology, showed that neonatal deaths were twice as high for babies born at home than babies born in hospitals.

However, for women with low-risk pregnancies, delivery in a hospital is associated with an increase in interventions like epidural analgesia, oxytocin use, episiotomy (an incision made on the perineum to speed delivery) and Cesarean section , he said.

Some studies from other countries have shown that for low-risk women, home births are as safe as hospital births. One Dutch study of 529,688 women, published in 2009 in BJOG: An International Journal of Obstetrics and Gynaecology, showed that there were no differences in babies' death rates during the first week after delivery between those born at home and those born at a hospital.

Despite this, Barth said he would not recommend home birth for any pregnant women at this time since no studies have been large enough to evaluate the differences in the risk of maternal death between home birth and hospital birth.

"There are rare complications, such as severe postpartum hemorrhage or amniotic fluid embolism that can happen to anyone in labor. Without the resources immediately available in a hospital, some of these women will die who could have otherwise survived," he said. "It only takes seeing this once or twice to make an impression. Personally, I've seen it enough to be convinced. I could never, in good faith, recommend a planned home birth."

Pass it on: Though still rare, home births are increasing in the United States. However, doctors warn that the practice can be dangerous.

Amanda Chan

Amanda Chan was a staff writer for Live Science Health. She holds a bachelor's degree in journalism and mass communication from the Walter Cronkite School of Journalism and Mass Communication at Arizona State University, and a master's degree in journalism from Columbia University.